Provider Demographics
NPI:1114341922
Name:GLIKSMAN, SHOSHANA (MSED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:SHOSHANA
Middle Name:
Last Name:GLIKSMAN
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:MRS
Other - First Name:SHOSHANA
Other - Middle Name:
Other - Last Name:GINIPRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:475 BALDWIN PL
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-2115
Mailing Address - Country:US
Mailing Address - Phone:917-501-2150
Mailing Address - Fax:
Practice Address - Street 1:475 BALDWIN PL
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-2115
Practice Address - Country:US
Practice Address - Phone:917-501-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-13-14184103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst